Systems and methods for documenting electronic medical records related to anesthesia

ABSTRACT

A system that displays a user interface for medical personnel to monitor and/or control the delivery medications such as anesthesia to a patient during a medical procedure. The system may gather patient data and other information from one or more patient monitors, one or more remote patient record information systems, one or more remote medical databases, and analyze various data to provide information for or to enable control of the administration of at least one medication or drug to a patient during a medical procedure such as an operation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application61/354,896 filed on Jun. 15, 2010, the entirety of which is incorporatedherein by reference.

BACKGROUND

Patient monitoring systems are widely used in the medical field toenable healthcare providers to monitor the condition of patients.Patient monitoring systems that store patient data or interface withmedical record databases may be referred to as electronic medical record(EMR) systems.

Some EMR systems automatically monitor clinical events, by analyzingpatient data from an electronic health record to predict, detect andpotentially prevent adverse events. Patient data may includedischarge/transfer orders, pharmacy orders, radiology results,laboratory results and any other data from services or healthcareprovider notes.

An electronic medical record is typically a computerized legal medicalrecord created in an organization that delivers care, such as a hospitalor doctor's office. Electronic medical records are often part of a localstand-alone health information system that allows storage, retrieval andmanipulation of records.

Existing EMR systems are susceptible to inefficient data entry,inaccurate or incorrect data entry, and tend to distract medicalpersonnel during data entry, especially during critical medicalprocedures. Accordingly, there is a need to enhance to ability ofhealthcare providers to more efficiently monitor and control theadministration of treatments to medical patients while also performinghealthcare data recording.

SUMMARY

The application, in various embodiments, addresses the deficiencies ofcurrent patient monitoring and management systems by providing systemsand methods including a patient management system that enables acaregiver, e.g., anesthesiologist, to more efficiently administermedications while monitoring a patient's status during a medicalprocedure, such as an operation.

In certain aspects, a system, such as a computer system, displays a userinterface for medical personnel to monitor and/or control the deliverymedications such as anesthesia to a patient during a medical procedure.The system may gather patient data and other information from one ormore patient monitors, one or more remote patient record informationsystems, one or more remote medical databases, and analyze various datato provide information for or to enable control of the administration ofat least one medication or drug to a patient during a medical proceduresuch as an operation. The system may gather information during anoperation and generate data for an interoperative medical record.

The system may also provide gathered or generated patient data to othermedical systems (e.g., patient records, billing, and the like). Thesystem user interface (e.g., GUI) may include user input and informationoutput features that enhance the user's (e.g., anesthesiologist) abilityto monitor a patient and control the delivery of medical treatment tothe patient. The system may interface with other medical systems such asa hospital patient data system, hospital billing system, doctor billingsystem, or insurance provider system. The system may gather informationfrom other systems or deliver data recording a medical procedure toanother medical record system.

The system may analyze or process certain data being collected so thatthe quality of the collected data is enhanced, by for example removingredundant data (artifacts) or eliminating irrelevant data so that thesystem user's time can be more efficiently directed to monitoring thepatient. The system may use certain charts or tables and a touch screento enable convenient user access to data in various portions of thechart. For example, the user interface display may provide a chart thatincludes intersecting lines (horizontal and vertical) as a user touchesthe display to more clearly show the user which cell of a chart to beselected.

The system may interface with a video camera and provide a view of apatient on a portion of the user interface to enable the user (e.g.,healthcare provider) to monitor the patient while interfacing with thesystem, e.g., charting patient data. The system may use variousinformation to control the delivery of medication/drugs to a patient, orto identify drug interaction or allergy issues for a patient. The systemmay synchronize data from multiple sources. The system may use accesscontrol (e.g., biometric authentication) to ensure that only authorizedpersonnel have system access a tandem DMS device advantageously includesfirst and second DMS filters that utilize separation mechanisms based ontwo different separation models.

More particularly, in certain aspects, the systems and methods describedherein include patient monitoring systems. The patient monitoringsystems may include at least one patient monitoring device formonitoring a physical condition of a patient in an operating room and avideo device for capturing a video image of the patient and transmittingvideo data associated with the video image. The patient monitoringsystems may include a controller unit having a communication interfaceand a user interface. In certain embodiments, the communicationinterface may be configured with circuitry for communicating with the atleast one patient monitoring device and the video device. The userinterface may include a display for displaying patient data and thevideo image of the patient to a user, and a user input device forreceiving at least one of instructions and data from the user. Incertain embodiments, the video image of the patient is positioned on thedisplay to enable the user to monitor the visual status of the patientwhile entering instructions or data via the input device. The userinterface may be configured to display at least one of the patient dataand the video image as an overlay over another visual element on thedisplay.

In certain embodiments, the patient monitoring systems include aplurality of patient monitoring devices, each in communication with thecontroller unit. One or more patient monitoring devices may include aphysiological monitors configured to measure at least one of heart rate,respiratory rate, blood pressure, oxygen saturation, SpO2, EEG, and theECG. Generally, the patient monitoring device may be in wireless and/orwired communication with the controller unit and/or the user interface.The patient monitoring device may also be in wired/wirelesscommunication with a remote device such as a laptop, PDA, or smartphone,or another type of computing device, such as a desktop personalcomputer. The remote device may, include among others, a cellular phone,personal digital assistant (PDA), smartphone (such as the Apple® iPhone®manufactured by Apple, Inc., located in Cupertino, Calif.), and a tabletcomputer or a mobile touch screen computer (such as the Apple® iPad®manufactured by Apple, Inc., located in Cupertino, Calif.).

The video device may include a camera configured to view at least aportion of the patient. In certain embodiments the video device includesa plurality of cameras, each configured to view at least a portion ofthe patient. Such embodiments may include a plurality of cameras thatare arranged to view different portions of the patient. For example,three cameras may be used whereby, one camera is arranged to view thehead portion, another camera is arranged to view the torso portion andanother camera is arranged to view a leg portion of the patient. Videoimages from each of the plurality of cameras may be transmitted from thevideo device simultaneously or in sequence, as desired. Video images maybe transmitted by the video device as a video stream. In certainembodiments, the video device includes a single multi-sensor cameracapable of viewing the entire patient and transmitting panoramic imagesof the entire patient.

In certain embodiments, the video device includes hardware and softwarecomponents configured to perform one or more of panning, tilting andzooming operations. In such embodiments, the controller unit may includehardware and software components for controlling these operations. Whenthe video device includes a plurality of cameras, each camera may beconfigured to independently pan, tilt and zoom to view differentportions of the patient. In certain embodiments, the user may controlone or more operations of the video device including at least one ofrecord, playback, pan, tilt, and zoom. In such embodiments, the user mayenter one or more commands, on a user input device of the userinterface, to control the operation of the video device, which in turnmay be processed by the controller unit and sent to the video device.For example, the user interface may include a touch screen and the usermay select on the touch screen visual elements (e.g., buttons, prompts)for selecting one or more of a plurality of cameras, the angle of thecamera, pan, tilt, zoom, exposure, and recording options.

Generally, the video device may be in wireless and/or wiredcommunication with the controller unit and/or the user interface. Thevideo device may also be in wired/wireless communication with a remotedevice such as a laptop, PDA, or smartphone, or another type ofcomputing device, such as a desktop personal computer. The remote devicemay, include among others, a cellular phone, personal digital assistant(PDA), smartphone (such as the Apple® iPhone® manufactured by Apple,Inc., located in Cupertino, Calif.), and a tablet computer or a mobiletouch screen computer (such as the Apple® iPad® manufactured by Apple,Inc., located in Cupertino, Calif.).

In certain embodiments, the patient monitoring system further includesan infusion device configured to deliver at least one of fluids, drugs,and medications to the patient. The infusion device may be in wirelessand/or wired communication with the controller unit and/or the userinterface. The controller unit may be configured to operate the infusiondevice based on at least one of user input received through the userinput device, data received from the at least one patient monitoringdevice, and video image received from the video device.

The controller unit may interface with the patient monitoring device,video device, infusion device, user interface and/or one or more localor remote data systems to determine the proper dose, infusion rate,and/or other treatment control applied to the patient. The controllerunit may gather and/or generate data based on data collected from one ormore monitors, video devices and provide such data to a local and/orremote system. In certain embodiments, the controller unit includes acommunications interface, and a user interface having a display and auser input device. The user interface may include a touch screen displaythat integrates the user input device and the user interface.

The controller unit may include hardware and software components forprocessing data received from the patient monitoring device, videodevice, infusion device, user interface, one or more local or remotedata systems, and one or more storage devices. In certain embodiments,the controller unit includes a data processing engine for enhancingquality of data collected. In such embodiments, the data processingengine may be configured to generate one or more medical charts based onthe patient data. The user interface may be configured to display theone or more medical charts to the user, and the user input device may beconfigured to modify, add or delete information contained in the one ormore displayed charts.

The controller unit may include circuitry for receiving andsynchronizing data from a plurality of sources. The data sources may belocated in at least one of local and remote locations. In certainembodiments, the received data includes at least one of patient data,drug data, drug interaction data, medical studies data, healthcare data,billing data, and insurance data. The controller unit may synchronizethe data in time or may organize the data in sequence of receipt.

In certain embodiments, the controller unit includes hardware andsoftware components for collecting and storing data from one or moresources. For example, according to one feature, the controller unit mayinclude hardware and software components to retrieve historical medicaldata. Such a feature allows for phantom recording of data from patientmonitors and/or other medical equipment, e.g., infusion device, beforean EMR may be created to enable retrieval of historical data. Thisfeature enables the controller unit to collect information from anetwork of monitors and machines and store data for later retrieval. Thecontroller unit can be used for electronic health record keeping systemsthat interface with patient monitors and medical equipments. Thecontroller unit gives an EMR system the ability to retrieve historicaldata. In certain embodiments, if a caregiver, e.g., an anesthesiaprovider, forgets to launch the EMR application, he/she will have theability to import the information automatically into the EMR system fromthe controller unit without having to manually import the past data.

In certain embodiments, the controller unit may include image processinghardware and software components for processing the video image or videostream received from the video device. The controller unit may beconfigured for processing the video image in real-time. For example, thecontroller unit may include hardware and software components formonitoring and tracking the patient's physical movement.

The controller unit may include hardware and software components forproviding enhanced security and data encryption. For example, enhancedsecurity may include access control, biometric authentication,cryptographic authentication, message integrity checking, encryption,digital rights management services, and/or other like security services.The security may include protocols such as IPSEC and IKE. The encryptionmay include, without limitation, DES, AES, RSA, and any like public keyor private key based schemes.

The controller unit may further include hardware and software componentsfor providing user access authentication. In certain embodiments, thecontroller unit includes an authentication engine for controlling accessto the user interface. The authentication engine may be configured toperform at least one of one-step physiometric and/or biometricauthentication with encryption. Instead of using a username/passwordchallenge-based authentication, the authentication engine may use aone-step authentication process using a physiometric reader.

In certain embodiments, the patient monitoring system includes an RFIDsensor in communication with the controller unit for verifying theidentity of the patient. In such embodiments, the controller unit mayinclude circuitry for matching patient data with the patient identifiedby the RFID sensor.

In another aspect, the systems and methods described herein include anintraoperative patient care controller unit for monitoring a patient.The patient monitoring controller unit may include a communicationinterface, a memory device, a processor, and a touch screen userinterface. The communication interface may include hardware and softwarecomponents for communicating with at least one of a patient monitoringdevice, video device, infusion device, and remote processing device,mobile device and storage device. The memory device may include hardwareand software components for storing at least patient data obtained fromthe at least one patient monitoring device and video images of a patientcaptured by the video device. The touch screen user interface mayinclude a display and an integrated user input device built into thedisplay. The touch screen interface may be configured to display patientdata and the video image of the patient to a user while concurrentlyreceiving at least one of instructions and data from the user. Incertain embodiments, the video image of the patient is positioned on thedisplay to enable the user to monitor the visual status of the patientwhile entering instructions or data via the input device.

In other aspects, the systems and methods described herein includemethods for monitoring a patient. The methods may include receivingand/or storing, at a controller unit, data representative of a physicalcondition of a patient, from at least one patient monitoring system, andreceiving and/or storing, at the controller unit, concurrently with thedata, a video image of the patient. In certain embodiments, the methodsinclude displaying, on a touch-screen user interface, simultaneously thedata and the video image, and allowing, on the touch-screen userinterface, a user to provide at least one of instructions and data.According to the methods described herein, the video image of thepatient may be positioned on the display to enable the user to monitorthe visual status of the patient while entering instructions or data viathe input device.

In certain embodiments, the methods further include generating, by thecontroller unit, one or more reports representative of at least one ofthe data representative of the physical condition of the patient anddata provided by the user. The controller unit may display these reportsto a user on the touch screen. In certain embodiments, the reports maybe displayed as a grid with cells that may be selectable by the user.The user may view and manipulate data in the report by touching andthereby selecting a cell in the report. The user may perform anysuitable operation on the report including, without limitation,selecting, editing, storing and printing the report, as desired. Incertain embodiments, when the user logs in into the system, the methodsinclude generating and displaying a report showing a list of patientsscheduled to be in the operating room. When the user selects a patient'sname on the screen, the controller unit may display a reportrepresentative of the physical condition of the selected patient.

In certain embodiments, the methods may include prompting the user forsecurity verification information, and based on the user's response,restricting use of the touch-screen user interface. For example, uponinitialization or start-up of the controller unit, the touch screendisplay may prompt the user for a username and password, or afingerprint. The user may be granted access to the patient monitoringsystem once the user's credentials have been verified by the system. Inanother example, even after the user has gained access to use thepatient monitoring system described herein, the user may be prompted foranother security verification to gain access to certain otherinformation (for e.g., personal identification information of patients).In certain embodiments, the patient monitoring system may not be incontinuous use and may consequently time-out. In such embodiments, thesystem may require the user to re-enter credentials when resuming use ofthe system.

In certain embodiments, the methods may include allowing a user toinput, on the touch-screen user interface, information relating to adrug to be administered to the patient, and operating an infusion deviceconnected to the controller unit based on the user input. The displaydevice on the user interface may be configured to display patient data,a video image of the patient and control buttons to allow a user tooperate the patient monitors and video device. The user interface mayfurther be configured to display control buttons to allow a user tooperate an infusion device. According to the methods described herein,the user, attempting to administer a drug to a patient using the patientmonitoring system, may be prompted on the user interface for informationpertaining to the drug or the patient. The user may also be prompted forauthentication information to verify that the user has the authority toadminister the drug and cross-verification that the correct drug isbeing administered.

The patient monitoring systems described herein may be used forpreoperative assessment, intraoperative patient care, postoperativepatient care and/or for reporting and analysis. In particular, thepatient monitoring systems described herein may be used to captureanesthesia information for preoperative evaluation including informationpertaining to disease and co-morbidity, information from lab andradiology reports and communication between perioperative team members.The patient monitoring systems described herein may also be used tocapture information intraoperative care including information frompatient monitoring devices, video devices, infusion systems, lab andpharmacy databases, and remote databases. The patient monitoring systemsdescribed herein may be used for postoperative patient care includingthe preparation of pain and procedure documentation, preparation ofdocumentation useful for postoperative rounds, billing submission, andcomplication tracking. The patient monitoring systems described hereinmay be used in reporting and analysis for generating reports, analyzingprovider performance, analyzing efficiency and utilization, calculatingpharmacy costs and usage and reviewing credentialing and compliance.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects and advantages of the systems andmethods described herein will be appreciated more fully from thefollowing further description thereof, with reference to theaccompanying drawings. The skilled person in the art will understandthat the drawings, described below, are for illustration purposes only.The drawings are not intended to limit the scope of the applicant'steaching in any way.

FIG. 1 includes a diagram of a system according to an illustrativeembodiment;

FIG. 2 includes a functional block diagram of a controller shown in FIG.1 according to an illustrative embodiment;

FIG. 3 includes screen image of a user interface that enables retrievalof historical medical data according to an illustrative embodiment;

FIG. 4 includes a screen image of a user interface including user accessauthentication according to an illustrative embodiment;

FIG. 5 includes a screen image of a user interface showingidentification of a patient using an RFID sensor according to anillustrative embodiment;

FIG. 6 includes a screen image of a user interface having a video imageof a patient according to an illustrative embodiment;

FIG. 7 includes a screen image of a user interface having an overlay ofimportant patent data and/or patient related alerts according to anillustrative embodiment;

FIG. 8 includes a screen image of user interface that enable control offluid and/or drug infusion of a patient according to an illustrativeembodiment;

FIG. 9 includes a screen image of a user interface having smart buttonsthat enable efficient entry of medication or fluids informationaccording to an illustrative embodiment;

FIG. 10 includes a screen image of a user interface having auser-specific template to enable more efficient event informationaccording to an illustrative embodiment;

FIG. 11 includes a screen image of a user interface having a touchscreen and an information grid that includes orthogonal lines to enhancea user's ability to locate the correct cell of the grid according to anillustrative embodiment;

FIG. 12 includes a screen image of a user interface that enables thesystem to identify redundant patient data and select the moreappropriate data to display according to an illustrative embodiment;

FIG. 13 includes a screen image of a user interface that enables a userto perform time linking between system detected time and the user'srecord times according to an illustrative embodiment; and

FIG. 14 includes a screen image of a user interface that provides adisplay of pharmacokinetic information such as plasma and target effectsite concentration of medication give to a patient according to anillustrative embodiment.

DETAILED DESCRIPTION

While the applicant's teachings are described in conjunction withvarious embodiments, it is not intended that the applicant's teachingsbe limited to such embodiments. On the contrary, the applicant'steachings encompass various alternatives, modifications, andequivalents, as will be appreciated by those of skill in the art.

FIG. 1 includes a diagram of an exemplary patient monitoring system 100.The patient monitoring system 100 includes a patient managementcontroller 102, patient monitors 104 and 106, a video monitor 108, andan infusion device 118. These various components are used to monitorvarious physical conditions of or control the administration of atreatment to a patient 116. The controller 102 may be connected to oneor more remote databases and/or systems via a network 114, such as,without limitation, a hospital record system 110 and/or a remoteinformation system 112. The network may include a LAN, WAN, wirelessnetwork, and/or the Internet. The systems 110 and/or 112 may includeEMRs or other patient-related data such as, without limitation, billingrecords and personal records. The systems 110 and/or 112 may includemedication data, drug data, healthcare data, medical reference data,studies information, outcome data, treatment data, statistical medicaldata, and the like. The controller 102 may interface with one or morelocal or remote data systems to determine the proper dose, infusionrate, and/or other treatment control applied to the patient 116. Thecontroller 102 may gather and/or generate data based on data collectedfrom one or more monitors 104 or 106 and provide such data to a localand/or remote system 110 or 112.

The monitors 104 and 106 may include physiological monitors capable ofsensing, without limitation, heart rate, respiratory rate, bloodpressure, oxygen saturation, SpO2, EEG, ECG, and like parameters. Themonitors 104 and 106 may be in communication with the controller 102 viaa local area network, wireless network, or other communicationsmechanism. The controller 102 may interface with an infusion device 118capable of delivery fluids, drugs, and/or medications to the patient116. The controller 102 may monitor and/or control the rate of infusionof one or more fluids administered to the patient 116. The video device108 may include a camera configured to view a portion of the patient 116such as their face, head, or other portion of the patient's body. Thevideo device 108 may be configured to send a real-time image of thepatient 116 to the controller 102 for display to a user of thecontroller 102, e.g., an anesthesiologist.

The patient 116 may be located in a hospital, operating room, medicaloffice, or facility for providing medical treatment. Various componentsof the system 100 may be co-located with the patient 116 or remotelylocated. For example, the monitors 104 and 106 may be located in anoperating room with the patient 116 to monitor the patients conditionduring an operation on the patient 116. The patient managementcontroller 102 may also be located in the operating room with thepatient 116. However, the controller 102 may be positioned in theoperating room such that the user of the controller 102, e.g., ananesthesiologist, does not have a direct or convenient view of thepatient 116. Thus, the user of the controller 102 may rely on a videofeed showing a portion of the patient 116 via a display 216 associatedwith the controller 102 while performing other tasks such as chartingpatient data and/or performing data entry. The patient 116 may bestanding, laying on a bed or other platform, or in some other position.

The controller 102 may utilize data from various local or remotelocations. For example, the controller may retrieve data regarding apatient from the system 110, which could include a local hospitaldatabase, and/or from system 112, which could include healthcare datalocated at a remote location. The various data accessible by thecontroller 102 may include patient data, drug data, drug interactiondata, medical studies data, healthcare data, billing data, insurancedata, and the like. The controller 102 may send data to various remotesystems such as systems 110 and 112. The controller 102 canadvantageously enable paperless and automatic data collection and/ordistribution of patient data while also performing quality controlchecks on the collected data. In some instances, the controller 102enables improved record keeping in support of pay for performance forinsurance records and improved compliance with medical standards and/orprocedures.

Various advantages of the system 100 include: 1) freeing up a caregiver,e.g., anesthesiologist, from charting by reducing the amount time andeffort needed by the user to perform charting, 2) improved patient careby increasing caregiver attention to patient during a procedure, 3)improved charting and documentation by enabling automatic and/or moreefficient data entry, 4) more timely data entry, 5) enabling tracking ofthe quality of certain information, 6) enabling more accurate recordingand/or patient billing, 7) enabling enhanced uses of data such as fordrug interaction analysis and use, 8) improving anesthetizing of patientbody locations. The system 100 may interface with another EMR system toprovide data to and/or retrieve data from the EMR system.

The system may operate in an operation room (OR) or non-OR environment.The system may collect certain patient related parameters frommonitoring one or more patients that may then be used for benchmarking,identifying normal or expected parameter ranges, identifying parameterranges associated with certain medical conditions and/or procedures,and/or for ensuring the quality assurance of medical procedures. Forexample, the system may be used to track and/or monitor that certaindrugs were administered during appropriate procedures and/or atappropriate times during the procedure. The system may be used todetermine that a procedure was performed in accordance with acceptedmedical standards, hospital policy, or some other requirements. Thesystem may be used to enable administrative or other personnel to ensurethat proper quality controls are adhered to during medical procedures.

FIG. 2 includes a functional block diagram of an exemplary generalpurpose computer system, e.g., patient management controller 200, forperforming the functions of the controller 102 of FIG. 1. The exemplarycomputer system 200 includes a central processing unit (CPU) 202, amemory 204, and an interconnect bus 206. The CPU 202 may include asingle microprocessor or a plurality of microprocessors for configuringcomputer system 200 as a multi-processor system. The memory 204illustratively includes a main memory and a read only memory. Thecomputer 200 also includes the mass storage device 208 having, forexample, various disk drives, tape drives, etc. The main memory 204 alsoincludes dynamic random access memory (DRAM) and high-speed cachememory. In operation, the main memory 204 stores at least portions ofinstructions and data for execution by the CPU 202.

The mass storage 208 may include one or more magnetic disk or tapedrives or optical disk drives or memory sticks, for storing data andinstructions for use by the CPU 202. At least one component of the massstorage system 208, preferably in the form of a disk drive or tapedrive, stores the database used for processing data and/or electronicmedical records of the system 100. The mass storage system 208 may alsoinclude one or more drives for various portable media, such as a floppydisk, a compact disc read only memory (CD-ROM), or an integrated circuitnon-volatile memory adapter (i.e. PC-MCIA adapter) to input and outputdata and code to and from the computer system 200.

The computer system 200 may also include one or more input/outputinterfaces for communications, shown by way of example, as interface 210for data communications via the network 212 (or network 114). The datainterface 210 may be a modem, an Ethernet card or any other suitabledata communications device. To provide the functions of a computer 102according to FIG. 1, the data interface 210 may provide a relativelyhigh-speed link to a network 212 (or network 114 of FIG. 1), such as anintranet, internet, or the Internet, either directly or through ananother external interface 116. The communication link to the network212 may be, for example, optical, wired, or wireless (e.g., viasatellite or cellular network). Alternatively, the computer system 200may include a mainframe or other type of host computer system capable ofWeb-based communications via the network 212. The computer system 200may include software for operating an network application such as a webserver and/or web client.

The computer system 200 also includes suitable input/output ports or usethe interconnect bus 206 for interconnection with a local display 216and keyboard 214 or the like serving as a local user interface forprogramming and/or data retrieval purposes. The display 216 may includea touch screen capability to enable users to interface with the system200 by touching portions of the surface of the display 216. Serveroperations personnel may interact with the system 200 for controllingand/or programming the system from remote terminal devices via thenetwork 212.

The computer system 200 may run a variety of application programs andstore associated data in a database of mass storage system 208. One ormore such applications may enable the receipt and delivery of messagesto enable operation as a server, for implementing server functionsrelating to patient management and/or information of FIG. 1.

The components contained in the computer system 200 are those typicallyfound in general purpose computer systems used as servers, workstations,personal computers, network terminals, and the like. In fact, thesecomponents are intended to represent a broad category of such computercomponents that are well known in the art. For example, the componentscontained in the computer system 200 are those found in mobile devicessuch as a laptop, PDA, or smartphone. The computer system 200 mayinclude, among others, a cellular phone, personal digital assistant(PDA), smartphone (such as the Apple® iPhone® manufactured by Apple,Inc., located in Cupertino, Calif.), and a tablet computer or a mobiletouch screen computer (such as the Apple® iPad® manufactured by Apple,Inc., located in Cupertino, Calif.).

As discussed above, the general purpose computer system 200 may includeone or more applications that provide patient management and informationcollection. The system 200 may include software and/or hardware thatimplements a web server application. The web server application mayinclude software such as HTML, XML, WML, SGML, PHP (HypertextPreprocessor), CGI, and like languages.

The foregoing embodiments of the systems and methods described hereinmay be realized as a software component operating in the system 200where the system 200 is Unix workstation or other type of workstation.Other operation systems may be employed such as, without limitation,Windows, MAC OS, and LINUX. In some embodiments, the controller 102software can optionally be implemented as a C language computer program,or a computer program written in any high level language including,without limitation, C++, Fortran, Java, or Visual BASIC. Certainscript-based programs may be employed such as XML, WML, PHP, and so on.Additionally, general techniques for high level programming are known,and set forth in, for example, Stephen G. Kochan, Programming in C, Hayden Publishing (1983). The system 200 may use a DSP for whichprogramming principles well known in the art.

As stated previously, the mass storage 208 may include a database. Thedatabase may be any suitable database system, including the commerciallyavailable Microsoft Access database, and can be a local or distributeddatabase system. The design and development of suitable database systemsare described in McGovern et al., A Guide To Sybase and SQL Server,Addison-Wesley (1993). The database can be supported by any suitablepersistent data memory, such as a hard disk drive, RAID system, tapedrive system, floppy diskette, or any other suitable system. The system200 may include a database that is integrated with the system 200,however, it will be understood by those of ordinary skill in the artthat in other embodiments the database and mass storage 208 can be anexternal element.

In certain embodiments, the system 200 may include an Internet browserprogram and/or be configured operate as a web server. In someembodiments, the client and/or web server may be configured to recognizeand interpret various network protocols that may be used by a client orserver program. Commonly used protocols include Hypertext TransferProtocol (HTTP), File Transfer Protocol (FTP), Telnet, and SecureSockets Layer (SSL), for example. However, new protocols and revisionsof existing protocols may be frequently introduced. Thus, in order tosupport a new or revised protocol, a new revision of the server and/orclient application may be continuously developed and released.

In certain embodiments, the system 100 includes a networked-based, e.g.,Internet-based, application that may be configured and run on the system200 and/or any combination of the other components of the system 100.The controller 102 (or system 200) may include a web server running aWeb 2.0 application or the like. Web applications running on thecontroller 102 may use server-side dynamic content generation mechanismssuch, without limitation, JavaScript, CGI, PHP, or ASP. In certainembodiments, mashed content may be generated by the web browser 144 via,for example, client-side scripting including, without limitation,JavaScript and/or applets.

In certain embodiments, the controller 102 may include applications thatemploy asynchronous JavaScript+XML (Ajax) and like technologies that useasynchronous loading and content presentation techniques. Thesetechniques may include, without limitation, XHTML and CSS for stylepresentation, document object model (DOM) API exposed by a web browser,asynchronous data exchange of XML data, and web browser side scripting,e.g., JavaScript. Certain web-based applications and services mayutilize web protocols including, without limitation, theservices-orientated access protocol (SOAP) and representational statetransfer (REST). REST may utilize HTTP with XML.

The controller 102 may also provide enhanced security and dataencryption. Enhanced security may include access control, biometricauthentication, cryptographic authentication, message integritychecking, encryption, digital rights management services, and/or otherlike security services. The security may include protocols such as IPSECand IKE. The encryption may include, without limitation, DES, AES, RSA,and any like public key or private key based schemes.

FIG. 3 includes a screen image of an exemplary user interface of thecontroller unit that enables retrieval of historical medical data. FIG.3 illustrates how the controller 102, in certain embodiments, enablesphantom recording of Anesthesiology data from patient monitors 104 and106 and/or other medical equipment, e.g., infusion device 118, before anEMR may be created to enable retrieval of historical data. This featureenables the system 100 to collect information from a network of monitorsand machines and store data for later retrieval. The system 100 can beused for electronic health record keeping systems that interface withpatient monitors and medical equipments. The system 100 and controller102 gives an EMR system the ability to retrieve historical data. Currentsystems can only capture present and future data as long as a softwareapplication is running that has established a connection with themonitors and medical equipments. Thus, if a caregiver, e.g., ananesthesia provider, forgets to launch the EMR application, he/she willhave the ability to import the information automatically into the EMRsystem from the controller 102 without having to manually import thepast data.

FIG. 4 includes a screen image of an exemplary user interface includinguser access authentication. In one embodiment, the controller 102enables one-step physiometric and/or biometric authentication withencryption. Instead of using a username/password challenge-basedauthentication, the controller 102 may use a one-step authenticationprocess using a physiometric reader. The physiometric data may then bedigitized, encrypted, and transmitted over a secure connection usingcertificate identification. The encryption may vary between eachauthentication routine and, therefore, be difficult for intruders todecipher and perform false authentication.

FIG. 5 includes a screen image of an exemplary user interface showingidentification of a patient using an RFID sensor in communication withthe controller 102. In certain embodiments, the controller 102 enablespatient verification integration leading to a one-step record creation.The patient management system 100 may identify the patient 116 either bybarcode scanning or RFID sensors and create a new record automatically.In current systems, the user has to choose a patient from a list andopen or create a record. The system 100 and/or controller 102 enables aquicker workflow by eliminating that process.

FIG. 6 includes a screen image of an exemplary user interface having avideo image of a patient. In certain embodiments, the system 100 enablesreal-time video streaming to the controller 102 to ensure adequatepatient monitoring. When a clinician spends time documenting anesthesiaevents or using the controller 102, it is often difficult to payattention to the patient. The present system 100 can be configured tostream video of the patient 116 onto the display 216 of the controller102. Such a feature provides a similar advantage as the technology usedin the automobiles where the speedometer data is projected onto thefront wind shield glass to enhance the user's attention.

FIG. 7 includes a screen image of an exemplary user interface having anoverlay of important patent data and/or patient related alerts. Incertain embodiments, the controller 102 provides always on top alerts,live monitors, and video streaming. The controller 102 can enableimportant aspects of an EMR to stay on top of multiple other windows ona computer desktop running on the controller 102. The computer, e.g.,controller 102, may be used for other tasks such as information lookupand medical imaging retrieval. The controller 102 enables the user to dothose tasks while paying attention to the important patient 116 dataduring anesthesia or another medical procedure.

FIG. 8 includes a screen image of an exemplary user interface thatenables control of fluid and/or drug infusion of a patient. In certainembodiments, the controller 102 includes a dial control medication andfluid entries interface via a touch screen display 216. The controller102 may include a software application having a software control dialwhich is preprogrammed with specific drug information such as default,minimum dosage, maximum dosage, and/or incremental dosage. As the userspins the software control dial, the application can increment dosageand/or fluid amounts or rates according to the specific incrementalrange for the specific medication, up to an upper limit. A default dosecan be user-dependent to enhance further customization. The applicationmay perform other analyses such as checking for drug interaction withother drugs or patient allergies.

FIG. 9 includes a screen image of an exemplary user interface havingsmart buttons that enable efficient entry of medication or fluidsinformation. In certain embodiments, the controller 102 may include aninterface having smart buttons. For example, the display 216 may includea touch screen capability and/or a set of controls that enable quickentry of medication or fluids information which is preprogrammed withdrug info and user preferences. The controller 102 may store specificdrug data along with the most usual dose as well as the user'spreference dose under a certain condition.

FIG. 10 includes a screen image of an exemplary user interface having auser-specific template to enable more efficient event informationrecording. In certain embodiments, the controller 102 may include a onetouch custom documentation feature. For each event that occurs duringanesthesia care (or some other medical treatment), each clinician oranesthesia provider may document the event differently. Instead oflimiting the users to document uniformly, the controller 102 may includea feature in which user-specific templates can be retrieved and pulledinto an edit area directly along with medical coding informationrelevant for future analysis.

FIG. 11 includes a screen image of an exemplary user interface having atouch screen and an information grid that includes orthogonal lines toenhance a user's ability to locate the correct cell of the grid. Incertain embodiments, the controller 102 enables data charting ofmedication, fluids, physiologic data using a grid celllocator/positioning feature. In order to fit a lot of information onto ascreen, a grid control is often used to track medication information.The problem with using a touch screen with these grids is that theuser's finger is often bigger than the grid box itself which makes itdifficult for the user to know which box was selected. The controller102 may provide one or more lines, including orthogonal lines, thatidentify the grid location, allowing the user to more easily identifywhich grid cell was selected.

FIG. 12 includes a screen image of an exemplary user interface thatenables the system to identify redundant patient data and select themore appropriate data to display. In certain embodiments, the controller102 manages and/or processes redundant clinical information using anapplication including a priority algorithm. There are sometimesredundant data collected from the patient monitors 104 and 106. Forexample, blood pressure may be measured invasively (transducing acatheter) or noninvasively (blood pressure cuff). When the controller102 has two sets of information that represent a somewhat similarcondition, the controller can take these information and process them todetermine which set should be the displayed data. The controller 102 mayuse a priority function where to user specifies which data should havepriority. Alternatively, the controller 102 may use an algorithm thatautomatically determines which data form which monitors should havepriority.

FIG. 13 includes a screen image of an exemplary user interface thatenables a user to perform time linking between system-detected time andthe user's record times. In certain embodiments, the controller 102enables a predefined event timing linkage feature. When a healthcareprovider is documenting his/her care for the patient 116, most eventswould include a time. However, it may be difficult to remember the exacttiming of events. The controller 102 can suggest a time based onprevious information captured from one or more time sources. Forexample, as a patient 116 enters the operating room, an RFID sensor cantrigger documentation of that event. That time is often the same time asthe operating room start time. By linking these events via thecontroller 102, users can fill out the time for events associated withthe patient 116 treatment more efficiently.

FIG. 14 includes a screen image of an exemplary user interface thatprovides a display of pharmacokinetic information such as plasma andtarget effect site concentration of medication give to a patient. Incertain embodiments, the controller 102 enables pharmacokinetic and/orpharmacodynamic data integration into an anesthesia EMR system. Thesystem 100 provides a novel way to display pharmacokinetic andpharmacodynamic data within an anesthesia electronic medical record.There are currently no anesthesia EMR on the market that have thecapability to display pharmacokinetic and pharmacodynamic data such asplasma and target effect site concentration of medications that aregiven to patients. The controller 102 may also provide additionalmodeling such as BIS prediction.

It will be apparent to those of ordinary skill in the art that certainaspects involved in the operation of the controller 102 may be embodiedin a computer program product that includes a computer usable and/orreadable medium. For example, such a computer usable medium may consistof a read only memory device, such as a CD ROM disk or conventional ROMdevices, or a random access memory, such as a hard drive device or acomputer diskette, or flash memory device having a computer readableprogram code stored thereon.

Variations, modifications, and other implementations of what isdescribed may be employed without departing from the spirit and scope ofthe disclosure. More specifically, any of the method and system featuresdescribed above or incorporated by reference may be combined with anyother suitable method, system, or device feature disclosed herein orincorporated by reference, and is within the scope of the contemplatedsystems and methods described herein. The systems and methods may beembodied in other specific forms without departing from the spirit oressential characteristics thereof. The foregoing embodiments aretherefore to be considered in all respects illustrative, rather thanlimiting of the systems and methods described herein. The teachings ofall references cited herein are hereby incorporated by reference intheir entirety.

The invention claimed is:
 1. A patient monitoring system, comprising: atleast one patient monitoring device for monitoring a physical conditionof a patient in an operating room during an operation on the patient; avideo device for capturing a video image of the patient during theoperation and transmitting video data associated with the video image;and a controller unit located in the operating room and configured tocontrol an infusion device coupled to the patient, the controller unitincluding a communication interface for communicating with the at leastone patient monitoring device and the video device, and a user interfacehaving a display for displaying to a user patient data and the videoimage of the patient during the operation, and a user input device forreceiving at least one of instructions and data from the user; whereinthe video image of the patient is positioned on the display to enablethe user to monitor the visual status of the patient during theoperation while entering instructions or data via the input device; andwherein the user interface includes a touch screen display thatintegrates the user input device and the display.
 2. The patientmonitoring system of claim 1, comprising a plurality of patientmonitoring devices, each in communication with the controller unit. 3.The patient monitoring system of claim 1, wherein the at least onepatient monitoring device includes physiological monitors configured tomeasure at least one of heart rate, respiratory rate, blood pressure,oxygen saturation, SpO2, EEG, and the ECG.
 4. The patient monitoringsystem of claim 1, wherein the video device includes a plurality ofcameras, each configured to view at least a portion of the patient. 5.The patient monitoring system of claim 1, wherein the controller unitincludes an authentication engine for controlling access to the userinterface.
 6. The patient monitoring system of claim 1, comprising anRFID sensor in communication with the controller unit for verifying theidentity of the patient.
 7. The patient monitoring system of claim 1,wherein the user input device includes one or more buttons preprogrammedwith at least one of drug information and user preferences.
 8. Thepatient monitoring system of claim 1, wherein the user interface isconfigured to display at least one of the patient data and the videoimage as an overlay over another visual element on the display.
 9. Thepatient monitoring system of claim 1, further comprising a mobilecomputing device having a touch screen in wireless communication withthe controller unit for viewing at least one of the patient data and thevideo image, and for receiving at least one of instructions and datafrom the user.
 10. The patient monitoring system of claim 1, wherein theinfusion device is configured to deliver at least one of fluids, drugs,and medications to the patient.
 11. The patient monitoring system ofclaim 10, wherein the controller unit is configured to operate theinfusion device based on at least one of user input received through theuser input device, data received from the at least one patientmonitoring device, and video image received from the video device. 12.The patient monitoring system of claim 1, wherein the controller unitincludes circuitry for receiving and synchronizing data from a pluralityof sources.
 13. The patient monitoring system of claim 12, wherein thereceived data includes at least one of patient data, drug data, druginteraction data, medical studies data, healthcare data, billing data,and insurance data.
 14. A patient monitoring controller unit,comprising: a communication interface for communicating with at leastone patient monitoring device and a video device; a memory device forstoring at least patient data obtained from the at least one patientmonitoring device during an operation on a patient and video images ofthe patient during the operation captured by the video device; aprocessor; and a touch-screen user interface, including a display fordisplaying patient data and the video image of the patient to a user,and a user input device for receiving at least one of instructions anddata from the user; wherein the video image of the patient is positionedon the display to enable the user to monitor the visual status of thepatient during the operation while entering instructions or data via theinput device; and wherein the patient monitoring controller unit isconfigured to control an infusion device coupled to the patient.
 15. Thepatient monitoring controller unit of claim 14, wherein the patient dataincludes ECG data.
 16. A method of monitoring a patient, comprising:receiving, at a controller unit, data representative of a physicalcondition of a patient during an operation, from at least one patientmonitoring system; receiving, at the controller unit, concurrently withthe data, a video image of the patient during the operation; displaying,on a touch-screen user interface, simultaneously the data and the videoimage; allowing, on the touch-screen user interface, a user to provideat least one of instructions and data; and operating, with thecontroller unit, an infusion device coupled to the patient; wherein thevideo image of the patient is positioned on the display to enable theuser to monitor the visual status of the patient during the operationwhile entering instructions or data via the input device.
 17. The methodof claim 16, further comprising generating, by the controller unit, oneor more reports representative of at least one of the datarepresentative of the physical condition of the patient and dataprovided by the user.
 18. The method of claim 16, further comprisingprompting the user for security verification information, and based onthe user's response, restricting use of the touch-screen user interface.19. The method of claim 16, further comprising storing, at thecontroller unit, data from the at least one patient monitoring system.20. The method of claim 16, further comprising allowing the user toinput, on the touch-screen user interface, information relating to adrug to be administered to the patient, and operating the infusiondevice based on the user input.
 21. The method of claim 16, wherein thedata representative of a physical condition of the patient includes ECGdata.